Country Eagle Dual Fan Module Order Form

	Quantity	Price
Dual Fan Module with misting system	_____	$_____________
Trailer for Dual Fan Module with electric hydraulic lift	_____	$_____________
Sub-Total		$_____________
50% Deposit required for order		$_____________
Balance Due		$_____________
All prices F.O.B. Bentonville, AR.

CUSTOMER Name ________________________ Address ______________________ City_______ST______ Zip _______ Phone_________ Fax ___________ Email_________________________ Signature______________________ Date________________

Print and email form to: Darrell Weiland, President 2280 West Centerton Blvd Centerton, AR 72719 Phone: (479)366-2286 jdweiland@cox.net